孕中期血清唐氏综合征筛查与不良妊娠结局关联

Serum screening for Down's syndrome in the second trimester of pregnancy is associated with adverse pregnancy outcomes

目的研究孕中期唐氏综合征筛查与不良妊娠结局关联及甲胎蛋白(AFP)、β人绒毛膜促性腺激素(β-HCG)、游离雌三醇(uE3)单个指标与不良妊娠发生的关联。方法采用连续性入组方法选取2014年3月31日至2021年4月29日在北京朝阳医院进行唐氏综合征筛查的孕妇进行回顾性队列研究。结果在7682例孕妇中,筛查高风险者492例,占6.40%;共有100例孕妇出现了不良妊娠结局(1.30%)。筛查高风险孕妇中有21例发生不良妊娠结局,发生率为4.27%,显著高于筛查低风险者(1.10%)。调整了糖尿病史、遗传病家族史、吸烟、饮酒后,与低风险值相比,筛查高风险者发生不良妊娠结局的可能性高达4.022倍(95%CI:2.405-6.442);21三体风险值越高,不良妊娠结局的发生率越高(P<0.001)。筛查高风险组在胎儿畸形、染色体异常、胎停育的发生率显著高于低风险组(P<0.05)。AFP原始数值每升高1 ng/mL,发生不良妊娠结局的可能性上升到1.019倍;AFP中位数倍数值(MOM)每升高1,发生不良妊娠结局的可能性上升2.258倍;uE3原始数值每升高1 ng/mL或uE3中位数倍数值每升高1,发生不良妊娠结局的可能性均可下降一半。结论孕中期唐氏综合征筛查高风险对胎儿畸形、染色体异常、胎停育等不良妊娠有提示作用;AFP高水平和uE3低水平可增加不良妊娠结局的发生。

Objective To explore the association between screening for Down's syndrome and adverse pregnancy outcomes.Methods Retrospective cohort study was conducted in Beijing Chaoyang Hospital covering pregnant 7682 pregnant women from Mar 31,2014 to Apr 29,2021 in a continuum period.Results The prevalence of high screening risk was 6.40%(492 cases)and the incidence of adverse pregnancy outcome was 1.30%(100 cases).The incidence of adverse outcome(4.27%)in high risk group was significantly higher than that in low risk group(1.10%).After adjusting for diabetes,family history of hereditary diseases,smoking and drinking alcohol,the incidence odds of adverse outcomes for high screening risk subjects was 4.022 times(95%CI:2.405-6.442)as that for low risk.The high Down's syndrome risk score meant high incidence of adverse outcomes(P<0.001).The incidences of malformations,chromosome abnormalities and stillbirth for high screening risk subjects were higherthan those for low risk.The incidence odds of adverse outcomes increased to 1.019 times with the increase of 1 ng/mL for AFP and 2.258 times with the increase of 1 for AFP MOM.The incidence odds of adverse outcomes declined to half with the increase of 1 ng/mL for uE3 or uE3 MOM.Conclusions Down's syndrome screening high risk is indicators for organ malformations,limb deformity,chromosome abnormalities and still birth.High level of AFP and low level of uE3 may increase the occurrence of adverse pregnancy outcomes.